Medical benefits to help with treatment costs for cleft lip and cleft palate conditions.
- you’re enrolled in Medicare
- you’re under 28
- before you turned 22 a doctor diagnosed you with a cleft lip, cleft palate or similar condition and you started treatment
To be eligible for treatment under the Cleft Lip and Cleft Palate Scheme you must:
- be enrolled in Medicare
- before turning 22 years of age, be certified by a health professional as having a cleft lip, a cleft palate, or other eligible conditions
- have started treatment by an approved health professional before turning 22, and
- be under the age of 28 when receiving treatment
You can only receive treatment under this scheme until you turn 28 years of age.
Your treatment under the scheme must start before you turn 22 years of age.
If you are over 28 years old and need repairs to reconstructive work previously provided under the scheme, your treating health professional can apply for approval for additional treatment.
Once you are over 28 years old, Medicare benefits can only be paid for any additional treatment if your health professional applies to us and the application is approved.
Treatment included under the scheme
The scheme provides Medicare benefits for a range of dental treatments carried out by certain health professionals, including:
- some orthodontic work
- both simple and surgical extraction of teeth
- some general and prosthodontic services by your family dentist, or
- oral and maxillofacial surgery
Before you have treatment, ask your health professional if they’re eligible to provide services under the scheme. If they aren’t, you may need to pay for the services they provide.